DESCRIPTION: Smoking continues to be the most preventable cause of death and disability in the United States. As many as 87 percent of lung cancer deaths are secondary to smoking, as well as 30 percent of all cancer deaths. The mortality trends in lung cancer rates for women are rising more rapidly than for men and lung cancer is the leading cause of death from cancers in women. Given the mortality trends in lung cancer for women and the link to their smoking patterns, cancer prevention efforts should focus on targeting high risk female mothers as well as take advantage of teachable moments to best accelerate progress toward smoking cessation in women. Economically disadvantaged pregnant women are both more likely to smoke prior to becoming pregnant and less likely to quit during pregnancy than other women of childbearing age. Even when they do quit during pregnancy, they are likely to relapse postpartum. Therefore, pregnancy and the postpartum period is an important window of opportunity for interventions to motivate these women and accelerate their progress toward smoking cessation. Reducing smoking in pregnancy and postpartum would serve to reduce health risks for two individuals, mother and child, thereby, promote the cancer prevention objectives set forth in Healthy People 2000. The proposed project is a collaborative effort of the Cancer Prevention Research Consortium at the University of Rhode Island and the Women and Infants Hospital of Rhode Island, a teaching hospital of Brown University Medical School. The proposed study is designed to evaluate the impact of an innovative stage-based individualized, interactive intervention (Individualized Intervention) on smoking cessation compared with a stage-matched self-help approach (self-help Intervention) and a standard care condition. The Individualized and self-help Interventions will be based on existing theoretical concepts and behavior change techniques of the Transtheoretical Model. The target population will be low-income culturally diverse pregnant women attending public maternity clinics. The proposed study will involve a prospective randomized, three-group, repeated measures design. Information gained from the project data will help determine the efficacy of this innovative smoking cessation intervention, identify the impact of the intervention on intermediate or process variables, and provide insight into the influence of pregnancy and delivery on readiness for changing smoking behaviors. The benefits of promoting smoking cessation programs during pregnancy will not only have a long-range impact on the individual, but also on the overall health of the family.